Acne is a common medical condition that affects men and women, teenagers and adults. Acne affects 40 to 50 million Americans and is the most common skin disorder. About 85 percent of people will have acne at some point in their lives, and by mid-teens, 40 percent of people will have acne or acne scarring.
What causes acne?
- First, excess sebum production (oily secretions of sebaceous glands)
- Second, plugging of hair follicles (or pores)
- Third, bacteria known as P. acnes
Do hormones influence acne?
- Yes, acne is seen in times of hormonal changes
- Neonatal period
- Around menses for women
What things can make acne worse - diet? stress? sweating?
- Stress can worsen acne – it increases sebum production, which clogs hair follicles.
- Sweating can cause an outbreak similar to acne caused by a yeast called pityrosporum folliculitis. This is a normal yeast that starts to overgrow in hair follicles.
- Diet can affect acne. High glycemic diets (sugar, carbohydrates) and dairy products can make acne worse.
What about over-the-counter treatments - do these work?
- The active ingredient in many over-the-counter treatments is benzoyl peroxide, which kills P. acnes bacteria. For mild cases, benzoyl peroxide alone may be effective. For more severe cases benzoyl peroxide can be combined prescription treatments such as retinoid cream (retin-A) and/or topical antibiotics.
- Another good over-the-counter treatment to use is a salicylic acid cleanser or cream. This helps unclog pores.
What are the side effects with treatment?
- Many of the topical treatments can cause dryness and irritation. The goal is to kill the bacteria and decrease sebum, but if this is overdone then you get dryness and irritation. Often times you need to start treatments slowly, 2-3 times a week and increase slowly.
- Those who require courses of oral antibiotics may experience stomach upset. Fortunately we have new slow release formulations that allow us to use lower doses with less stomach irritation.
Are there any ways to prevent acne?
- Wash your face daily with a mild cleanser. Rough scrubs or harsh cleansers can make acne worse by causing more inflammation.
- Use oil-free non-comedogenic makeup and skin products. These are formulated so they will not clog pores.
- Eat a low carbohydrate diet. A diet high in sugar and carbohydrates causes spikes in blood glucose that can worsen acne
Dermoscopy is the examination of skin lesions with a Dermatoscope. A Dermatoscope is a tool, which traditionally consists of a magnifier light-source device that when used by a trained specialist allows for enhanced inspection of skin lesions.
Why do we use dermoscopy?
- To help differentiate a malignant from a non-malignant skin lesion.
- To observe an analyze skin lesions without the hindrance of skin surface reflections.
- It may also allow clinicians to determine the surgical margin for skin cancers that are difficult to define with the naked eye.
What are the advantages of using dermoscopy?
- Better diagnostic accuracy of skin cancers.
- Reduction in unnecessary biopsies and excision operations of benign lesions.
- Diagnosis of very early skin cancers.
- Monitoring dark moles for changes.
What training is required to perform dermoscopy?
- Many Dermatologists gain expertise in residency from various trained physicians.
- Annual conferences focus presentations on the latest techniques on using dermoscopy.
- Literature and research is continuously being published from Dermatologists who specialize in dermoscopy.
What is eczema?
- The word “eczema” is derived from a Greek word meaning “to boil over”, which is a good description for the red, inflamed, itchy patches that occur during flare-ups of the disease.
- Eczema is the general term for any type of dermatitis or inflammation of the skin.
- When eczema develops in childhood it is often called “atopic dermatitis” and can be a life-long condition.
What causes eczema?
- Atopic dermatitis can be inherited and is caused by a defective skin barrier. The skin does not do a good job of keeping moisture in the skin and irritants and allergens out.
- Atopic dermatitis often coexists with other “atopic” or allergic conditions such asthma and hay fever.
- Eczema often gets worse with certain triggers such as dry skin, infection, allergens, stress, heat, and sweating.
Is eczema caused by food allergies?
- Some people with eczema have food allergies, but it is often not the primary cause for their eczema.
- The diagnosis of food allergies should be done by a physician and verified with a food challenge. Severely limiting a diet can be dangerous.
What are the treatment options for eczema?
For most eczema I start with a three-part approach:
- Good skin care – mild fragrance-free cleansers, short warm showers or baths, and thick moisturizers immediately after bathing
- Topical steroids to any areas with a rash
- Antihistamine medications (like Benadryl) to control the itching
When these measures don’t control the eczema then sometimes oral steroids, antibiotics, light treatment or stronger immune suppressing medications can be used.
Are topical steroids safe to use?
- Topical steroids are safe if the correct strength is used in the correct location for the correct length of time.
- Problems occur when people use a strong topical steroid on their face that is meant for their hands. Be sure to follow your doctor’s instructions for topical steroid use.
What are some skin care tips for people with eczema?
- It is okay to take a bath or shower every day, just keep it short (10 minutes) and use warm, not hot water.
- Use non-soap cleansers such as fragrance-free body washes. These are less likely to strip the skin of its natural oils.
- Apply topical steroids and moisturizers to the skin while it is still moist. This helps “seal” extra moisture in the skin.
- Greasy ointments like Vaseline or Aquaphor are the most moisturizing, followed by creams (in tubs), then lotions (in pumps).
What is photodynamic therapy?
Photodynamic therapy or PDT is a treatment that uses special drugs, called photosensitizing agents, along with light (referred to as Blue Light) to kill cancer cells. The drugs only work after they have been activated or “turned on” by certain kinds of light.
Over a certain amount of time the drug is absorbed by the cancer cells. Then light is applied to the area to be treated. The light causes the drug to react with oxygen, which forms a chemical that kills the cells.
What are Actinic Keratosis?
- Actinic keratosis (AKs) are rough – textured, dry scaly patches on the skin that are caused by excessive UV exposure such as sunlight.
- They can range in color from skin-toned to reddish brown and can be as small as a pinhead or larger than a quarter.
- They occur most often on the face, scalp and ears.
Who is at risk of developing AK's?
Individuals with a higher likelihood of developing one or more AKs are those with:
- Fair skin
- Blond or red hair
- Blue, green or grey eyes
- Those over 40
- History of kidney disease or weakened immune system
- Daily long-term exposure to the sun
- Multiple severe sunburns early in life
*AKs develop as the result of years of sun exposure and are cumulative over time.
*Even if you didn’t suntan much, years of simple tasks can add up to significant damage (i.e. walking the dog, playing a sport, going to the mailbox).
When is the best time to have blue light therapy?
- Plan 2-3 weeks before attending important events – weddings, reunions, photos, etc.
- You will be in the office 1.5-2 hours for your appointment.
- Plan to stay out of the sunlight or direct light from the car window for 48 hours after treatment.
What should I purchase for my appointment?
- Bring a wide-brimmed hat so you will have good coverage on your way home from your treatment.
- A gentle facial cleanser and moisturizer such as Cetaphil or CeraVe products.
- Sun Block with an SPF of at least 30 (ask your nurse about our EltaMD sunscreen line).
What should I expect during my appointment?
- Your face will be cleansed using acetone to ensure all oils have been removed from the skin.
- A medicine called Levulan, will be uniformly applied to your AK lesions.
- You will sit in the waiting room as the medicine soaks in anywhere from 60-120 minutes.
- A blue light box will be positioned around your face or scalp and protective eyewear will be worn.
- The blue light treatment will take approximately 17 minutes.
What does the blue light feel like?
- The blue light is of low intensity and will not heat the skin.
- During the treatment, you may experience sensations of burning tingling, stinging or prickling of the treated AKs.
- The feeling of discomfort should subside as early as 1 minute after treatment. Any UV exposure within 48 hours after treatment can result in increased discomfort.
What should I expect after treatment?
- The AKs and surrounding skin may redden, swell and scale.
- Peeling and scabbing is expected and should resolve by 4 weeks.
- Wear sunscreen daily as a sunburn can delay your healing from the treatment and cause more sun damage.
Who should NOT have the blue light treatment?
- If you have a cutaneous photosensitivity.
- If you have a diagnosis of porphyria or know allergies to porphyria.
- If you are claustrophobic when objects are enclosed around your face/scalp.
Psoriasis is the most common autoimmune disease in the U.S., affecting as many as 7.5 million Americans. Psoriasis occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells, resulting in painful red, scaly patches on the body that bleed and itch. Psoriasis frequently occurs with a range of other health concerns including diabetes, hypertension, heart attack and depression.
What causes psoriasis?
Psoriasis is a chronic, noncontagious, multisystem, inflammatory disorder that can affect the skin, scalp, nails, and occasionally the joints. It is characterized by raised, inflamed, red lesions covered by a silvery white scale. It is typically found on the elbows, knees, scalp, and lower back.
What are the triggers for psoriasis?
Stress, injury to the skin, medications, and infections can all precede the onset of psoriasis or make it worse.
What is the prognosis for psoriasis?
Although psoriasis is usually benign, it is a lifelong illness with remissions and exacerbations and is sometimes refractory to treatment.
What is the link between psoriasis and cardiovascular disease?
A systematic review of 90 studies confirmed that patients with psoriasis had a higher risk of ischemic heart disease, stroke, and peripheral arterial disease but also a greater prevalence of risk factors for cardiovascular disease, compared with controls. Those with more severe psoriasis, such as those requiring oral medications, had even higher risks.
- Psoriasis is a systemic inflammatory disorder and it is believed that inflammation is involved in atherosclerosis, the etiology of cardiovascular disease.
- Psoriasis and cardiovascular disease share common risk factors: obesity, smoking, heavy alcohol consumption, high blood pressure, lipid abnormalities, insulin resistance, and diabetes.
What can be done to help psoriasis?
Diet and Exercise: A high BMI (25 or higher) is associated with an increased incidence of psoriatic outbreaks, so this is another important reason to eat nutritiously, exercise, and maintain a healthy body weight. Alcohol and smoking can also make psoriasis worse, so it is important to reduce or eliminate these, especially during flares.
Stress plays a major role in the occurrence of psoriatic outbreaks, so it is especially important for those with psoriasis to keep stress it in check. Meditation, yoga, and acupuncture are all effective stress relievers.
Sunlight can be an effective treatment for psoriasis, because it contains ultraviolet B (UVB) rays, which have been shown to suppress inflammation in the skin. To minimize harmful UV exposure, it is best to receive phototherapy (light) treatments in the safety of a doctor’s office.
What are the teatment options for psoriasis?
Management of psoriasis may involve medications, light therapy, stress reduction, and various adjuncts such as sunshine, moisturizers, and salicylic acid. Topical treatments include moisturizers, steroid creams, Vitamin D creams, and salicylic acid.
- Light therapy treatments include narrowband UVB, PUVA, and the Excimer laser.
- Oral medications that interact with the immune system and normalize the proliferation of skin cells.
- Biologic medications that target specific areas of the immune system that are up-regulated in psoriasis.
It is reported that more than 2 million cases of skin cancer occur in the United States each year. One in five Americans will get skin cancer in their lifetime. Every hour someone will die of melanoma in the United States. You can help prevent and detect skin cancer with the help of your dermatologist.
What is skin cancer?
Skin cancer develops when damaged skin cells cannot repair themselves and begin to grow and divide uncontrollably, forming a tumor.
Skin cancer generally develops in the outermost layer of skin, usually allowing detection in its early stages.
What causes skin cancer?
Skin cancer most frequently results from exposure to ultraviolet (UV) light, which harms the DNA with repeated exposure. In addition to repeated exposure to UV light outdoors, you are at increased risk of skin cancer if you:
- Frequently use tanning beds
- Regularly smoke cigarettes
- Have a suppressed immune system, such as if you suffer from leukemia or are an organ transplant recipient, because your immune system cannot ward off cancerous cells as effectively as healthy individuals.
What are the different types of skin cancer?
Basal Cell Carcinoma (BCC) – the most common form of skin cancer usually appears on sun-exposed areas (face, ears, scalp, upper trunk) and may look like a blemish that won’t heal or a shiny, pearly bump that does not go away. It may bleed if minor trauma occurs to that area. Alternatively, basal cell carcinoma my look like a rough, reddened patch. BCC tends to grow slowly and rarely metastasizes.
Squamous Cell Carcinoma (SCC) – the second most common type usually occurring in sun exposed areas but can develop anywhere on the body. They may arise from pre-cancerous lesions called actinic keratosis which are dry, scaly lesion. Typically they look like a red, crusted bump or rough scaly patch.
Melanoma – the most lethal form of skin cancer because it can spread to the lymph system and internal organs. If often develops in an existing mole or a new mole. Typically they are brown to black lesions that have uneven borders, colors or surfaces. When they appear on sun-damaged skin such as the face, melanomas may look like a brown patch or unevenly colored freckle. Self skin checks are so important to detect changes in existing moles and to spot new ones.
How is skin cancer treated?
There is a wide range of skin cancer treatments available. Your provider will discuss the appropriate treatment based on several factors including but not limited to:
- The type of skin cancer
- The location of skin cancer on your body
- If the skin cancer is an aggressive form and if it is deep and/or has spread to surrounding tissues or to other parts of the body
- Your physical health
Understanding skin cancer treatments
The goal for treating skin cancer include different types of surgery as well as a variety of non-surgical procedures.
The goal in treating skin cancer is to completely remove the cancerous area, which can be achieved through different surgical procedures which include:
- Mohs surgery involves saving the optimal amount of healthy skin while removing the cancerous area completely. Performing this procedure requires a dermatologist with exceptional skills and specialized additional training in Mohs surgery, such as Dr. Pennie. Because this method immediately verifies the complete removal of the cancerous tissue, Mohs surgery offers the highest success rate of all skin cancer treatments – up to 99%, according to the American College of Mohs Surgery. Learn more by reading Mohs Surgery FAQs.
- Excision involves removing the skin cancer and a small amount of skin that appears healthy, known as the margin. This procedure is typically performed in a dermatologist’s office. The specimen is then sent to an outside laboratory to verify the entire skin cancer has been removed.
- Curettage and electrodessication: This method may be appropriate for treating small basal cell and squamous cell skin cancers. It typically involves a scrapping and cauterizing technique to destroy the cancerous cells.
Non-Surgical Skin Cancer Treatments
Surgery is not always the right treatment choice, such as when the patient’s health may preclude surgical options or additional treatment after surgery may be required. If skin cancer is detected early, surgery may not be needed. In such cases, one of the following treatments may be used:
Immunotherapy: If your dermatologists recommends this option, your own immune system will be used to treat the cancer. As part of immunotherapy, you will apply a prescription cream to your skin under the guidance of your dermatologist. The cream, Imiquimod, modifies the way in which your immune system responds.
Chemotherapy: For very thin, superficial skin cancers, your dermatologist may prescribe a topical chemotherapy. The medication is applied topically to the affected area and will destroy the abnormal skin cancer cells. New healthy skin will develop in the treated area once it has healed.
Photodynamic therapy: To perform this procedure, your dermatologist will apply a chemical to the area of skin cancer. After the chemical has been on your skin for a few hours, your dermatologist will have you expose that area to a special light, which destroys the cancer cells.
Radiation therapy: Radiation treatment is usually reserved for patients who have very large tumors and would be disfigured by surgery, or for patients who are unable to have surgery due to other health problems. This method typically requires up to 30 separate treatments over a period of weeks.
Who gets skin cancer?
- Skin cancer is more likely in those with fair skin, light colored eyes, blonde or red hair and those who tend to freckle or sunburn. However, anyone of any color can develop skin cancer.
- A family history of skin cancer increases your risk of developing skin cancer.
How can I prevent skin cancer?
- Wear a sunblock of at least SPF 30 year round to sun exposed skin. Make sure your sunblock protects against both UVA and UVB light, the most harmful rays of the sun.
- Wear protective clothing such as a wide-brimmed hat, UV protective shirt and sunglasses; seek shade and avoid the sun during “peak hours” of 10 a.m. to 4 p.m. when the suns rays are the strongest.
- Reapply your sunblock every 2 hours when outdoors and more frequently if you’ve been sweating or swimming.
- Self- check and familiarize yourself with your skin with monthly self skin exams. Be aware of changes in the size, shape and color or your moles and let your dermatologist know of any lesions that are tender, bleeding, itching or not healing after 2-3 weeks.
- Do no use UV tanning beds. Self tanning lotions are a safer way to get a tanned look.